Can Lyme Disease Cause a Stroke? A Case of Lyme Neuroborreliosis

Stroke-like symptoms may rarely occur with Lyme neuroborreliosis
Neurologic complications can complicate diagnosis
Early recognition may influence recovery

“We here describe the case of an 83-year-old man for whom we strongly suspect Lyme neuroborreliosis as the etiology of his stroke,” writes Moreno Legast and colleagues in Case Reports in Neurological Medicine.

Patients often ask whether Lyme disease can cause a stroke, trigger stroke-like symptoms, or contribute to neurologic complications. Although uncommon, Lyme neuroborreliosis has been described in case reports involving ischemic stroke and cerebrovascular complications.

The patient was admitted to the emergency room complaining of right-sided weakness and speech difficulties, which had developed over a 24-hour period.

Multiple imaging studies revealed a recent ischemic lesion in the left corona radiata, as well as a small left parietal lesion. There was no evidence of hypertension, large vessel disease, or a cardiac source.

Investigating Stroke Risk in Lyme Neuroborreliosis

Instead, the workup revealed a positive lupus anticoagulant in a patient who did not have a history of venous or arterial thrombosis or autoimmune disease.

Because of the presence of a lupus anticoagulant antibody, the authors tested for infectious and autoimmune causes. According to Moreno Legast, antiphospholipid antibodies are associated with different infectious diseases. They also note antiphospholipid antibodies have been reported in chronic Lyme disease.

Infectious and immune screenings were negative. But ELISA and Western blot testing for Lyme disease came back positive.

Clinicians then reassessed the patient, carefully reviewing his history. The man reported multiple tick bites over several years but did not recall any rash. He also had paresthesias with tingling in his hands and feet 2 years earlier which lasted 4 months.

Learn more about neurologic complications in neurologic Lyme disease.

Spinal Fluid Findings and Diagnostic Uncertainty

Further testing included a spinal tap showing elevated protein levels of 0.71 g/L and an increased CSF/serum antibody index for Lyme IgG of 27.5 but no pleocytosis.

Pleocytosis refers to an increased white blood cell count in cerebrospinal fluid.

“According to the European Federation of Neurological Societies diagnostic criteria, our patient had a possible but not definite Lyme neuroborreliosis because of absent CSF pleocytosis,” explains Moreno Legast.

This case highlights how diagnosis may remain uncertain even when neurologic symptoms and laboratory findings point toward infection. Learn more about delayed Lyme disease diagnosis.

Treatment and Recovery

“Considering the possibility of stage 3 Lyme neuroborreliosis with cerebrovascular complications, antibiotic treatment with intravenous ceftriaxone 2 g per day was administered for 14 days,” Moreno Legast states.

The antiphospholipid antibodies were negative at 6 weeks.

“The patient slowly improved and was discharged a few weeks later,” according to Moreno Legast. He could walk with a cane but still had severe right arm weakness.

“This case reminds us that, even after standard pharmacological treatment, Lyme neuroborreliosis can lead to long-term sequelae,” the authors write.

Moreno Legast and colleagues did not address whether additional antibiotic therapy might have been helpful.

Frequently Asked Questions

Can Lyme disease cause a stroke?

Stroke related to Lyme disease appears uncommon but has been reported in case reports involving Lyme neuroborreliosis and cerebrovascular complications.

Can Lyme disease cause stroke-like symptoms?

Yes. Lyme disease can affect the nervous system and may cause neurologic symptoms including weakness, numbness, speech difficulties, or facial paralysis, which may resemble stroke symptoms.

Can a tick bite cause a stroke?

Tick-borne infections have rarely been associated with neurologic complications including stroke, though these complications appear uncommon.

What is Lyme neuroborreliosis?

Lyme neuroborreliosis refers to nervous system involvement caused by Lyme disease and may affect the brain, spinal cord, or peripheral nerves.

Can neurologic symptoms persist after treatment?

Some patients may experience persistent neurologic symptoms despite treatment, particularly after severe neurologic involvement.

Clinical Takeaway

This case highlights how Lyme neuroborreliosis may occasionally present with severe neurologic complications including stroke.

Stroke-like symptoms, unexplained neurologic findings, and tick exposure history may warrant consideration of Lyme disease in selected cases.

Related Articles

These related articles explore stroke, neurologic complications, delayed diagnosis, and Lyme disease manifestations affecting the nervous system.

Untreated Lyme disease triggers stroke in a child
Stroke as a manifestation of Lyme disease
Cognitive issues following Lyme-related stroke
Lyme neuroborreliosis in children
Persistent Lyme disease

References

1. Moreno Legast G, Schnider A, Nicastro N. Ischemic Stroke: Do Not Forget Lyme Neuroborreliosis. Case Rep Neurol Med. 2018;2018:1720725.

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Dr. Daniel Cameron, MD, MPH
Lyme disease clinician with over 30 years of experience and past president of ILADS.

Symptoms • Testing • Coinfections • Recovery • Pediatric • Prevention